Women & ACL Injuries: Know Risks, Steps for Prevention
August 10, 2021
Whether you’re a casual jogger or elite athlete, you’re at risk for an injury to your anterior cruciate ligament (ACL). If you’re a woman, you are at even greater risk for these injuries.
But there are steps you can take to prevent them.
“Among athletes, women are more than twice as likely to have an ACL injury than men,” says Nithin Natwa, M.D., a sports medicine specialist and primary care physician at Henry Ford Health System. “Once you have an ACL injury, you are at greater risk for having further soft tissue injuries in the future. That’s why it is important to prevent these injuries and follow your treatment plan if injured.”
What Is An ACL Injury?
An ACL injury is a strain or tear in the ACL, one of the four major ligaments that support the knee so it can flex and bend. The ACL is a strong band of tissue that helps connect your thigh bone (femur) to your shin bone (tibia). “An ACL injury usually occurs without contact when you turn suddenly while running or land off-balance on one leg. These actions overload the knee joint and cause the ACL to be torn,” says Dr. Natwa.
In the United States, 100,000 people have ACL injuries each year. Anyone can experience an ACL injury, though athletes participating in sports like football, basketball, soccer and gymnastics are at highest risk. And summer is a peak time for outdoor sports injuries.
Seek immediate care if you have any of these signs of an ACL injury:
• An audible “pop” in the knee
• Intense knee pain and rapid-onset swelling (within hours)
• Loss of range of motion
• An unstable feeling or locking of your knee
The most common treatment for ACL injuries is surgery followed by physical therapy. After treatment, you can expect to return to normal activities in 6 to 9 months. However, peak athletic performance can take up to two years.
Why Are Women At Higher Risk For ACL Injuries?
According to Dr. Natwa, the differences in athletic training techniques for males versus females have left women at greater risk for ACL injuries. “There has been more emphasis on overall conditioning and mechanics for boys participating in sports compared to girls,” he says.
As a result, women are at greater risk for ACL tears and sprains due to:
• Differences in neuromuscular control: Without conditioning from an early age, women may not have the same ability to land and perform athletic motions that men do. For example, women are at higher risk for an ACL injury after landing from a jump.
• Strength imbalance for muscles that support the knee: Female athletes tend to have more defined quadriceps muscles but weaker hamstrings than men, putting them at greater risk for injury.
According to Dr. Natwa, there are many theories about women’s risk for ACL injury that lack scientific evidence, including:
• Width of the pelvis: Some people have suggested that the wider width of a woman’s pelvis puts more pressure on the knee joint and increases the risk for injury. However, this difference has not been shown to impact a women’s risk for ACL tears or sprains.
• Knee anatomy: The ACL runs through a section of the femur called the intercondylar notch. Women tend to have a narrower notch than men. Regardless of gender, individuals who possess smaller notch dimensions appear to be at greater risk for injury than individuals with larger notches.
• Hormones: Men and women have different hormone levels. But there is currently no concrete evidence that female hormones place women at higher risk for ACL injures.
Steps To Prevent ACL Injuries – Conditioning Early, Often
“The best way to prevent ACL injuries is to begin and maintain regular conditioning exercises at an early age,” Dr. Natwa says. “The more frequently you engage in proper exercises, the lower your risk for injury.”
Consult with a sports medicine specialist, physical therapist or athletic trainer to develop a training routine to prevent ACL and other injuries. Your training program should include exercises that:
• Strengthen the muscles that support your knee: Add strength training to build up your calves, hamstrings and quadriceps muscles. These muscles help stabilize your knee as you move. By strengthening these muscle groups evenly, you can lower your risk for injury.
• Improve overall neuromuscular control: Focus on adding neuromuscular exercises that train your nerves and muscles to react and communicate. For example, you may work on your balance by standing on one leg or sit upright on an exercise ball for short periods of time. And core exercises can strengthen the muscles that support your abdomen and back and help improve your posture as you move. These moves can strengthen your joints and help you learn appropriate balance and technique.
“Exercise really is the best medicine. It can improve your balance and agility as you participate in a sport or prevent injury as you move through your daily activities,” says Dr. Natwa. “Consider adding these exercises to your wellness program.”
Dr. Nithin Natwa is a sports medicine doctor who sees patients at Henry Ford Macomb Health Center in Chesterfield and Henry Ford Macomb Orthopedics and Wound Care in Clinton Township.
Want to learn more? Henry Ford Health System sports medicine experts are treating the whole athlete, in a whole new way. From nutrition to neurology, and from injury prevention to treatment of sports-related conditions, they can give your athlete a unique game plan. To find a sports medicine physician at Henry Ford, visit henryford.com or call 1-800-436-7936.
5 Strategies To Improve Range Of Motion
March 6, 2024
When it comes to health and fitness, regular exercise and strength training get the most attention. But it turns out that improving your range of motion may pay greater dividends, particularly over the long haul.
“All kinds of things can impact our range of motion,” says Jennifer Burnham, an athletic trainer at Henry Ford Health. “As we age, our joints become less pliable, but any kind of surgery or injury can also impact our range of motion. And if you're somebody who sits at a desk all day long, that can affect your range of motion as well.”
Why Is Improving Flexibility Important?
Staying active with regular cardiovascular exercise and strength training is a great way to maintain your overall physical health. But it’s important to remember that flexibility exercises come with plenty of perks, too, including:
- Preventing injury
- Staving off arthritis by lubricating joints and tissues
- Improving posture and balance
"Unfortunately, if you have limited range of motion, you may perform tasks incorrectly, causing other muscles and joints to overcompensate for the lack of mobility,” Burnham says. “Over time, that compensation mechanism can increase the risk of injury.”
To complicate matters, our lifestyles often don’t support our range of motion goals. Many of us spend most of our days sitting at a desk or hunched over a screen. And when we’re not sitting still, most of us are slouching.
What Are Some Ways To Improve Range Of Motion?
You don’t have to be able to twist your limbs into a pretzel to achieve full range of motion. Instead, try to improve on your current level of flexibility with these five simple strategies:
- Pay attention to timing. If you’re not ready to add a stretching day to your workout regimen, consider adding a set of flexibility exercises at the end of every session. Pre-workout stretching is helpful, too, but stretching when your muscles are warm is a more effective way to stave off injuries.
- Focus on mobility and stability. Even if you can do the splits or touch your toes to the back of your head, you won’t be able to hold the position if you don’t also have strong core muscles. “Most people do stabilizing exercises such as strength training and lifting weights without paying much attention to mobilizing activities like stretching and yoga,” Burnham says. “But you really need to do both stabilizing and flexibility exercises to get an effective workout.”
- Do a mix of dynamic and static stretches. Two types of stretches can help you gain an edge when it comes to improving range of motion: Dynamic (an active type of stretching where you’re moving within your range of motion) and static stretching (where you hold a stretch). Dynamic stretching with arm and head circles, side stretches, and hip circles before exercise is a good way to warm up cool muscles and help lubricate the joints. With static stretching such as touching your toes to stretch your hamstrings, the goal is to hold a position for 30 seconds or more. Static stretches are often best performed after a workout when your muscles are warm.
- Try foam rolling. Foam rollers act almost like a rolling pin to smooth out tight muscles. Used correctly, they can help improve range of motion — and release stress and tension. You can use foam rollers to prime your body for exercise, or to recover after a workout.
- Aim for balance. If one part of your body is super flexible, focus on increasing range of motion in the opposing muscle group. “So, for example, if your hamstrings are very flexible, make sure to target your quadriceps with flexibility exercises,” Burnham says. “The goal is to make sure you’re aiming for balancing in your body.”
While stretching is an important way to achieve and maintain balance, flexibility and range of motion, it isn’t always intuitive. Not sure where to begin? Consider meeting with a personal trainer or athletic trainer to help you devise a program.
“Watching YouTube videos can be helpful, but if you’ve never done flexibility exercises before, you could overstretch your muscles or find yourself in an incorrect position to stretch,” Burnham says. “And yes, you can create bodily injury by overstretching.”
To find a sports medicine provider at Henry Ford Health, visit henryford.com/sportsmedicine or call 313-651-1969.
Reviewed by Jennifer Burnham, MS, AT, ATC, CSCS, a certified athletic trainer at the Henry Ford Center for Athletic Medicine.